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| |     Parvovirus B19 Infections in Sickle Cell Disease by Lewis Hsu, M.D., Ph.D. reviewed by Lynn Cates, M.D., F.A.A.P. Parvovirus B19, which is responsible for a common childhood viral infection called fifth disease, or erythema infectiosum, can cause unusual problems in people with sickle cell disease. In most people, fifth disease is marked by some or all of the following symptoms: a mild cold, low fever, a lacelike rash on the upper arms and thighs, and a distinctive bright red rash on both cheeks (accounting for its other name, slapped cheek disease). It is spread by airborne droplets (e.g., cough, sneezing, runny nose) and exposure to blood, and it can be transmitted from a mother to her fetus. This is an extremely common disease--about half of all people will have had the infection sometime before reaching adulthood. Effect of parvovirus B19 on red blood cell production Parvovirus B19 also can cause a temporary infection of the bone marrow cells, shutting down production of red blood cells (RBC) for about 10 days. In most people, this temporary marrow shutdown is not a problem. However, since people with sickle cell disease (or other blood problems such as hereditary spherocytosis or thalassemia) depend on brisk production of red blood cells to replace their rapidly destroyed sickled cells, even temporary marrow shutdown can cause severe worsening of anemia for about two weeks. During the time that red blood cell counts are lower than usual, patients can become very pale, fatigued, and complain of a severe headache. Sometimes a blood transfusion is needed. Doctors will watch the reticulocyte count closely during a parvovirus B19 infection in sickle cell, because a reticulocyte count of zero is a fairly strong clue that infection still is active. Other problems that can be seen in sickle cell disease during a parvovirus B19 infection include pneumonia, splenic sequestration, and vaso-occlusive pain. What can you do about parvovirus B19? When you hear of a fifth disease (or slapped cheek disease) outbreak in your child's school, consider either taking him out for a while or watching him carefully for pallor or other problems. Parvovirus B19 infection appears to give lifelong immunity afterward, so your child should only catch this once. However, he can develop a similar-but usually milder-bone marrow shutdown from some other viral infections. Currently, no vaccine is available to prevent parvovirus B19 infections, but one is in development. Parvovirus also causes major problems for a developing fetus, so pregnant women should avoid contact with children with parvovirus infection. This may include putting a sign on the hospital room door to warn pregnant healthcare workers or family friends not to enter without a mask. People with cancer or AIDS also can develop complications from parvovirus B19 infections, so should exercise caution when visiting a child with this disease.
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